7 Nutrition Myths These Dietitians Are Busting

When people learn I’m a registered dietitian/nutritionist (RDN), they almost immediately start venting their frustrations about food issues. “Every day it’s another thing you can’t do or eat.  One day a food is good for you, the next day it’s bad for you.”  Since confused consumers make no changes, I always try to bust their myths and misinformation.

While consumers may be confused about food fads, RDNs are not.  They’re fed up with them.  They’re trained to spot hype, fads, and myths around a blind corner and it annoys them to no end. I asked some RDNs who have particularly good communications skills to tell me which popular nutrition fads really grind at them.  Here’s what they said:

Carbo-phobia!

Mindy Hermann, MBA, RDN, said straight up, “I wish people would stop thinking carbs are the devil.”  She’s had it with a near universal demonizing of these essential macros. 

Sure, most people eat too much added sugar, but she’s right that all carbs seem to be lumped together, whether it’s whole wheat bread or soda.  “Today it’s keto, yesterday it was Paleo, so many others before,” she said.  “I’m tired of all the iterations of high-protein, restricted carbs.”

Plant “Milk” Deserves No Halo

Nutritionally, plant-based diary alternatives just can’t hold a candle to the nutrition in real milk, according to Salge Blake, EdD, RDN, FADN, professor of nutrition at Boston University and the host of the hit health and wellness podcast, SpotOn! In addition to being a dynamite protein source, “Cow’s milk is chock full of vitamin D, calcium, and potassium, three nutrients that many Americans are falling short of in their diets.”  Dairy alternatives only have these nutrients if they’re added, and they often aren’t.  Unfortunately, says Salge Blake, “plant-based milks may also contain added sugars, adding calories and no additional nutrition to your glass.” 

Salge Blake also sees the affordability of real milk as a win-win.  “When it comes to your wallet, plant-based milks can be at least twice the price of cow’s milk.  For the nutrients and the money per gulp, you can’t beat low fat or skim dairy milk.”  If you’re allergic or vegan, soy is the closest alternative.  Be prepared to pay though.

Stop Kicking The Canned Foods!

Shari Steinbach, MS, RDN, spent years working directly with consumers as a retail dietitian in supermarkets, is fed up with canned foods getting dissed when they offer so many advantages:

  • Sustainability: “90% of cans are recycled and they can be recycled indefinitely.” Linings are safe, with 90% containing none of the controversial BPA.
  • Convenience: They have a long shelf life and that helps prevent wasted food and wasted food dollars.
  • Nutrition: “You can cut 40% of the sodium in canned beans and veggies just by rinsing and draining them,” Steinbach says. Since 9 in 10 people don’t eat enough vegetables, “Canned beans and tomatoes count,” towards scoring enough of this critical food group, and are a, “convenient, nutritious way to balance your diet.”

Want her recipe for quick, veggie-loaded, chili using canned ingredients?  “Here’s a favorite simple chili recipe that I made this week”:

  1. Brown 1 pound of lean ground beef;
  2. Drain and add 2 cans of chili-seasoned beans and 2 cans of undrained diced tomatoes.
  3. Season to taste with cumin or chili powder. “Serve with a green salad and whole grain crackers. Enjoy!”

Don’t Panic If It’s Not Organic

That’s advice from Leslie Bonci, MS, RDN Owner of Active Eating Advice, who is fed up with food elitism.  I see her point.  I spent decades working with low-income families who will never be able to afford organic food.  They shouldn’t worry.  They can still put delicious, nutritious food on the table. 

“What do we even mean when we say clean?” Bonci says, because “clean eating” has no definition.  That leaves every definition up to whomever is spewing it and that’s a perfect recipe for consumer confusion, fear, and doubt.  Instead, Bonci favors creating “an enabled table where foods of all price points have a place.”

White Foods Are Bright Foods!

Liz Ward, MS, RDN, Author of Better is the New Perfect is bugged by all the attention given to putting “only the most colorful fruits and vegetables on your plate.”  Forget colors, she says.  “Instead of worrying about what types of produce are “best,” simply include the types you like, no matter how pale,” Ward advises.  Besides, white, brown, and tan produce, such as mushrooms, cauliflower, potatoes, and bananas, are just as worthy as their brighter counterparts,” are loaded with nutrition.

“And while we’re at it, can we stop shaming starchy vegetables, such as corn, potatoes and peas? They are packed with nutrition and starch is a form of energy.”  It’s true, these foods are hugely important to so many food cultures and have sustained people for thousands of years.  Empty calories they most certainly are not. 

One Diet DOESN’T For Everyone?  Seriously?

“The nutrition belief that I hope goes to its final resting place in 2020 is that a single diet plan, or way of eating, is right for everyone,” declares food anthropologist and nutrition communications consultant Robyn Flipse, MS, MA, RDN.  Looking ahead, Flipse feels personalized nutrition, not fad dieting, holds the most promise in the years ahead.  

Leah McGrath, MS, RDN, corporate dietitian for Ingles Supermarkets, couldn’t agree more.  “It seems like every year we have a new ‘hot’ diet,” she says.  “However, just like our fingerprints,  we should want to and  deserve to individualize our eating plans.” 

Flipse continued, “The one thing we’ve learned from the decades of fad diet trends we’ve endured is that none of them have delivered on what they promised because they have all overlooked our metabolic differences.”  They also tend to be extreme, which is probably why people burn out on them. 

Flipse admits that we still lack the scientific tools to allow us to tailor nutrition to each person’s needs.  Unfortunately, when consumer demand gets ahead of the science, charlatans see an opportunity to market all kinds of pseudo-scientific gimmicks.

Plant-Based Doesn’t Mean Plants-ONLY

This one is mine.  I’ve written about it before and everyone in 2019 seemed to be jumping on this bandwagon.  Thing is, there’s no universal definition of “plant-based!” 

What it DOESN’T mean is vegan.  Eating a plant-based diet doesn’t automatically guarantee your diet is balanced or healthful, either.  Living on soda and chips is a fully “plant-based”, vegan diet.  And it ain’t balanced.  A huge salad with 10 different veggies, some nuts, and crumbled feta or parmesan cheese or a couple of ounces of beef or salmon is not vegan – but it IS plant-based.  Flipse put it best, “I tell people if 50% or more of what they eat is plants, then they have a ‘plant-based’ diet.”

Foodie Alert! Finding New Fruits & Veggies At NY Produce Show

If you want to know what brings out the “food nerd” in this registered dietitian/nutritionist, watch me at the New York Produce Show and Conference.  It’s the “trade show” for growers and distributors of all kinds of produce from all over the country and I jump for joy to attend. 

It’s all fruits and vegetables, but you get a preview of what will be happening for consumers in the months ahead, including many of the new varieties of fruits and vegetables that either haven’t hit the market yet or that are readying for national distribution.  It also give me a chance to speak with the growers themselves and learn what they’re hearing from consumers. 

A few highlights (not compensated — these thoughts are my own):

Convenience Rules 

Consumers like fruits and veggies but they don’t’ want to prep, slice, or peel it.  They want turn-key food, and produce folks realized they had to get on this bandwagon if they were going to get, and keep, people interested in buying and eating fresh produce. 

Everywhere in the exhibit halls were display cases featuring pre-cut “ingredients” like cleaned and ready-to-roast cauliflower and Brussels sprouts, chopped onions and peppers and of all manner of “stringy” veggies (think zoodles but with both winter and summer squash varieties).   

Then there were the new ready-to-eat “finger foods”, mostly cut fruits but there were some surprises.  “Watermelon stix”?  That’s right – watermelon cut in the shape and size of thick French fries!  No knives needed and ready for kids (and adults) to grab from the fridge.  I tasted them and was amazed at how crisp they were.  This owes to the value of plant breeding – new varieties are bred to lose less water when they’re cut and maintain the firmness of the flesh but still have the sweetness you’d expect from ripe watermelon..  They’ll come in both the traditional red and the newer golden varieties, both seedless.

New Varieties of Old (and not-so-old) Favorites

Koru Apples

Developed in New Zealand, grown domestically in upstate New York.  Jim Allen of New York Apple Sales explained that the Koru apple hits the trifecta – it’s good raw, cooked, or baked –yet holds its crispness without turning mushy or “floury”.

I’m a die-hard apple lover and I put this one to the test.  Jim gave me a Koru to take home and I kept it in my backpack for four days to see how it would hold up. When I bit into it I found it amazingly crisp.  A tart, yet sweet flavor with no astringency.  Thumbs up.  Bonus: the Koru has a smaller core, so you can eat more of it with less waste.

They’re available from October through March.  If you see them in your market, grab them. 

 

Honey persimmon

People have strong feelings about persimmons, especially the Hachiya persimmon, shaped like a huge acorn. It’s tricky to eat because it tastes best when it’s really soft, but some people are turned off by the almost gelatinous texture.  Eat it before then, when it’s firm, and it’ll pucker your mouth.  The Fuyu persimmon can be eaten hard, like an apple (it’s one of my favorite fruits and I’ve written about it here). 

At the show I tasted a “Honey persimmon”, a Hachiya variety from Brandt Farms in Reedley, California, that looks much like a traditional Hachiya but doesn’t require softening to eat it.  It’s absolutely delicious.  Dave Maddux of Brandt Farms described it as having a lot of mango notes with a hint of cinnamon and he was spot on.  Production was minor this year but Maddux said 2020 the honey persimmon will be busting out nationwide.  They’re a winter fruit, full of nutrients and antioxidants like potassium, vitamin C and carotene, have fiber and add some great variety to the usual winter fruits.  Don’t pass this one up.  Since they look like the regular Hachiyas, the Honeys will be bagged and labeled.

Brandt Farms also grows the Fuyu persimmon – also known as a “Sharon fruit” and – full disclosure – he gave me a bag of them.  We sliced them crosswise, thinly, spread them with goat cheese, topped with another slice, then rolled the sides in chopped almonds.  Guests at our holiday party went crazy for them.  Thanks, Dave! 

Eating the Dragon

Dragon fruit has been around for years in markets but a big push is on by growers to make them more mainstream.  Dragon fruit is related to the cactus family and the outside betrays a sweet, white flesh inside, studded with tiny seeds.  The taste and texture might remind you of a kiwi-pear hybrid.  Most common are the red ones, but now they share space with a yellow variety.  Nutritionally, it’s got game: a reasonable source of calcium, good fiber, and antioxidants (the red fruit has the same pigment that gives beets their color).  The only drawback: they’re a bit pricey.  But hey, they’re definitely worth trying.  I did, and I liked them.   

 

Holidays, Eating, & Why Everyone Needs This “Drug”!

NO ONE wants to hear about health stuff this month.  Save that for January!  We want our “once-a-year-foods”, so stay out of the way or we’ll squash you like a grape!  And why not?  Food that’s around once a year should be eaten and enjoyed.  I’ll even join you.

But holidays can be challenging.  There are always more things to do than time in which to do them: buying gifts, heading to social occasions, hosting them, cooking foods you have only once a year (how did I cook that last year?), and on.  All on top of the usual stuff called “life.” 

Your “Dream Drug”

If you could invent a drug for this time of year, you’d probably want it to:

  • Burn excess calories
  • Act like a statin to lower your cholesterol
  • Improve your heart’s health
  • Lower your fasting blood glucose
  • Help you cut stress
  • Give you a “mood lift”
  • Improve your sleep
  • Add some lean muscle
  • Help you think more clearly

If you could patent this drug and market it, you’d be richer than Jeff Bezos, who would be begging you to sell it on Amazon.

This “drug” isn’t in a bottle.  It’s in your shoes: physical activity.  It does ALL the things listed above and you can get all those benefits.

Registered dietitian nutritionist, Leslie Bonci, should know, as the owner/founder of www.activeeatingadvice.com, she says, “Exercise is the gift that gives your body the lift it needs during the holidays.”  This isn’t just an opinion, either.  Read on.

Hot Off the Research Press: Thinking Won’t Help You Exercise, But Exercise Helps You Think

This study, just out, looked at the cognitive outcomes of four older adult groups: those who did moderate physical activity three days a week (walking or biking), ate a DASH diet (Dietary Approaches to Stop Hypertension), those who did both and a control group that received only dietary education.

Best neurocognitive improvement at 1 year?  The group that did BOTH aerobic activity and the DASH eating style.  Second best was the aerobics-only group.  No surprise to Bonci.  “Getting moving helps to circulate blood to the brain,” she says.  

Why I Love This Study

  • The participants were at least 55 years old. If these folks can do it, it can be done by most people. 
  • The activity wasn’t extreme. No marathons, no sweating until exhaustion, just walking or stationary biking for 35 minutes, thrice weekly. Just move, then move on. 
  • DASH eating style? Also easy-peasy: It’s 2½ cups of fruits and veggies and two servings of dairy foods – what we should be doing anyway!   

Starting Moving

Baby steps here.  Registered dietitian Liz Ward’s philosophy says it all. “My mantra is that any movement is better than none to relieve tension and help you sleep better.”  Even her website is called “BetterIsTheNewPerfect

No time to do that walk?  Try doing it for half your lunch hour, so it doesn’t use any valuable “off” time.  FYI: a “brisk walk” is about 100 steps a minute.

This time of year, Ward admits her workouts may be shorter or even less frequent, but she knows the benefits go way beyond calorie-burning.  “I try to exercise as much as my schedule allows because physical activity is a huge stress-buster for me.”

Start “DASH-ing” 

Getting those 2½ cups (total) of fruits and veggies and two servings of dairy is easier than you think.  No specific fruits or vegetables here, and it’s cooked or raw, so choices are up to you.  For dairy, even some cheese is fine (an ounce per serving), but mix it up.  Examples:

  • Dairy: a cup of REAL milk on your cereal
  • Greek yogurt at breakfast, lunch, or for a snack or even dessert (with some of that fruit!).
  • Fill a pint plastic container (the kind that holds the won-ton soup form Chinese take-out) with any combo of fruits and veggies – that’s 4 servings right there – so you’re almost done for the day.

Cut to the Chase Bonus: Start now and you’re (literally) miles ahead of everyone else come New Years! 

15 Tips: Prevent G.E.R.D. From Being “Thanksgiving’s Revenge”

“National G.E.R.D. Awareness Week” is November 18-24 this year — a week BEFORE Thanksgiving, but maybe that’s good.  Being aware of this annoying condition can help you avoid it.

What’s “GERD”? It stands for “gastro-esophageal reflux disease”.  Back in the day, it was commonly known as “heartburn.”   It happens when the acid from your stomach backs up into your esophagus and it burns the hell out of it.  Your stomach is well-equipped to handle the stomach acids it produces to aid digestion, but the esophagus is much more sensitive.  When stomach acid gurgles up into the esophagus, it’s painful. 

A big Thanksgiving meal can trigger GERD even if you rarely experience heartburn.  Why?  Your stomach is only so big.  When you eat more than the stomach can handle, the sphincter muscle between the stomach and the esophagus may not close completely (see the graphic).  When stomach acid is released to start digestion in the stomach, some of that acid bubbles up and you feel a burning sensation. 

How to prevent GERD and Enjoy Your Thanksgiving Meal

The International Foundation for Gastrointestinal Disorders (IFFGD) put out this great graphic with 15 tips for avoiding GERD.  I’ll explain each one:

  1. Eat the meal earlier. It gives you more time to digest your food.  Having a big dinner in the the evening is a sure-fire way to get heartburn. 
  2. Serve (and eat) light appetizers. The Thanksgiving meal is an important tradition.  Save valuable tummy space and spend calories on the meal, instead of on typical nibbles.  A couple of bites of something and leave it at that.
  3. Stay active! Keeping moving helps your stomach empty itself a little sooner.  No marathons or vigorous exercise here, but any movement more than sitting down is a good idea.
  4. Don’t smoke. Add “heartburn irritant” to the list of reasons to avoid smoking.  Enough said.
  5. Nix the juice. The acid in fruit juice is much tamer than stomach acid, but can still bother the esophagus. Fruit nectar fares better, but if you must have juice, dilute it at least 1:1 with water.
  6. Limit the drinks. Alcohol is a known trigger for reflux.  It relaxes the esophageal sphincter, allowing stomach contents to back its way into the esophagus, but it can aggravate tender tissue on the way down, too.  Another trigger drink: regular coffee.  Keep it to decaf.
  7. Season lightly. This is individual, but some known irritants are things like chili peppers, tabasco, and hot sauces like salsa. They may not like you as much as you like them.
  8. Pass on deep-frying your turkey. I’d add, “and anything else.”  Fried foods trigger GERD symptoms in many folks, so be warned.  If you must eat them, think “taste” or a bite instead of a portion.
  9. Use smaller plates. It’s amazing how well this works.  If you’re int the habit of having seconds, try using a salad plate.  Then a second helping doesn’t have to mean overeating.
  10. Trade the soda for water. Bubbly stuff creates gas.  Gas puts upward pressure on that sphincter again and risks blowing acidic stomach contents into the esophagus. 
  11. Watch the desserts. Two reasons: 1) They’re heavy, just at the time your stomach is probably already full.  2) They’re usually really fatty (pie crust especially, but cake as well).  Best bet? Eat the filling in a small portion of pumpkin pie.  Hold the whipped cream and the a-la-mode.
  12. Skip the after-dinner mint. Peppermint oil – the flavoring – isn’t a “spice” but it’s just as irritating to the stomach and the esophagus.  It’s NOT a “digestive”. 
  13. SLOW DOWN! Make that salad plate-sized portion last at least 20 minutes – the amount of time it takes for your brain to register fullness, so don’t get there before the brain does!  Then ask yourself if you even want any more.  And remember, this is a time to get social.  Try and say something to everyone at the table.
  14. Stay awake. And upright.  People can feel comatose after a big meal (another reason to eat less).  Laying down after eating just makes it easier for stomach contents to back its way up into your esophagus and give you GERD symptoms.  Empty stomachs are better sleep companions.
  15. Talk to your doctor. Get relief!  There are medications available if you suffer from GERD symptoms frequently. 

Above all, may you enjoy the day, remember to be thankful.  My very best to you and your family.

Wanna “Meat Up”? New Research Says Risks Are Lower Than Thought

Well, the meat wars have resumed. When new research suggests that the advice people have heard to eat less meat might have been based on weak evidence, and the New York Times sees fit to make it front page news, you know it’ll be one of the most talked about topics in the food and nutrition world. Pass the popcorn.

It was bound to happen: red meat has been touted as unhealthy, processed meat even worse. Yet lean meat is nutrient-rich and can have a place in your diet if you so desire it.  Several new studies, all published September 30 in the Annals of Internal Medicine, concluded the following:

• “The absolute effects of red and processed meat consumption on cancer mortality and incidence are very small, and the evidence is low to very low”.

• “Low- or very-low-certainty evidence suggests that dietary patterns with less red and processed meat intake may result in very small reductions in adverse cardiometabolic and cancer outcomes.”

• The panel conducting the research made a “weak recommendation” for consumers to continue their consumption of meat, noting that “the desirable effects (a potential lowered risk for cancer and cardiometabolic outcomes) associated with reducing meat consumption probably do not outweigh the undesirable effects (impact on quality of life, burden of modifying cultural and personal meal preparation and eating habits).”

• Regarding reduction of cancer and heart-related diseases, they found “Low- or very-low-certainty evidence suggests that dietary patterns with less red and processed meat intake may result in very small reductions in adverse cardiometabolic and cancer outcomes.”

• Omnivores happen to like eating meat and were averse to changing, even “when faced with potentially undesirable health effects.”

Meat Wars & Culture Wars

None of these latest studies addressed animal welfare or environmental impact of meat consumption. The EAT-Lancet report did however, and looked at an omnivore diet from an environmental and sustainability standpoint, namely that eating meat and all animal foods was unsustainable for the planet. This could be perceived as strategic, as it makes the consumption of animal foods an issue for virtually everyone, not just people interested in health. This “bad-for-the-planet” approach strives to change global dietary culture, almost excluding the consumption of meat and most animal foods.

One thing seldom addressed: meat and animal foods as part of food culture:

• Are the Spanish going to forego their famous Iberian ham, which goes into so many dishes, even diced and added to sautéed vegetables?

• Are the Italians ready to give up their prosciutto and melon?

• Is it realistic to expect cultures to bid farewell to Peking duck? Shish-kebob? Sauerbraten? Sega Wat (Ethiopian beef stew)?  

• Would the French give up omelets?  Cheese, yogurt and milk?

These foods are rooted in centuries of culture and history the world over. As for eating meat, people happen to like it. One of the studies in the Annals concluded that omnivores happen to like eating meat and were averse to changing, even “when faced with potentially undesirable health effects.”

But Are YOU overeating Beef?

Right now, average daily intake of beef is about 2 ounces, or 14 ounces per week. If you keep it to that, and choose the many lean cuts that are available now, you’re probably fine and are also getting the best of the nutrition that beef has to offer. Dairy foods are even more efficiently produced, provide excellent nutrition, and are under-consumed (and underappreciated, IMHO). Make sure to include these, especially low-fat yogurt and milk, if you eat animal foods.

Omnivores can – and should – maintain a plant-based diet, so aim for plenty of fruits, veggies, and beans.

As for the planet, all agriculture in the US generates about 9% of the country’s greenhouse gas, with beef taking up just about 2%. Beef production in this country is amazingly efficient, far more so than in the rest of the world. Indeed, one criticism – a fair one – of the EAT-Lancet report is that it lumped all agriculture together, not focusing on the efficient production of animal foods in more developed countries.

Given the difficulty of changing global food cultures, it may be more useful to help improve the efficiency of global animal agriculture to the level present in developed countries.

Why Population Studies Are “Associated” With Limitations

Sigh…another week, another population study “linking” a food with a health consequence. This just-published study involved 70,000+ participants in the Japan Public Health Center–based Prospective Cohort looked at the “association” between plant and animal protein intake and mortality from heart disease, cancer, and “all-cause” mortality (a.k.a. “death from any reason”). 

Here’s what it concluded:

  • Higher intakes of plant protein were “associated” with lower cardiovascular-related and all-cause mortality.
  • Animal protein, per se, was NOT associated with any of these mortalities.
  • If red and processed meat was replaced with plant protein, it was “associated” with lower mortality from cancer, cardiovascular disease, and all-cause mortality — according to their statistical models, which did include some assumptions.

These population or “epidemiological” studies typically recruit thousands of people, use a questionnaire to get their dietary pattern – usually only at the study’s start, then check their health status 20+ years down the road.  The researchers then conclude that what participants ate when they filled out that food questionnaire was “associated” with their health outcome two decades later. 

Essentially, it gets a lot of statistics and draws a lot of conclusions based on what these people ate on a Tuesday 20+ years ago. 

When you see it laid out like that it’s almost comical.  That’s fine, but too often it’s given more credit than it deserves.

Plant protein is great. But it’s not the only way to ensure good health.
(Photo: pixabay.com)

Some Fine Print

This study took a single dietary assessment at the start and never again. Would it be fair to base your current health status on what you ate on a Tuesday 20 years ago? Eating habits change, as do activity levels. These factors may actually skew the results toward less dramatic differences, but again, it’s unknown. To be fair, the authors acknowledge that the possibility for “residual confounding in the association between plant protein and mortality remains.”

Some other potentially confounding variables:

• The high plant protein eaters also ate at least 300 FEWER calories than those eating more animal protein.
• High consumers of plant protein ate more fruits and vegetables in general, compared with the high consumers of animal protein.

Mortality from various causes has so many variables.  It’s hazardous to attribute it all to diet.  In commenting on yet another population study, Frank Mitloehner, professor of Animal Science at the University of California, Davis, who specializes in agricultural productivity and environmental sustainability, felt, “The correction for confounders is near impossible. It is difficult to know what the relative risk of one such variable is on morbidity and mortality.”  He actually gives “little credence” to these nutrition population studies.

When Statistics Aren’t Reality

These studies produce tons of numbers that are “statistically significant”.  The problem, too often, is that they may not be “clinically” significant. 

Example: take two empty Olympic-sized swimming pools.  Put a drop of water into one, and three drops into the other.  The second pool has THREE TIMES the water that the first one has.  Easy to show this statistically.  The problem: the statistics are meaningless because no one should dive into either pool.

Population Studies CAN’T Show Cause-and-Effect

They’re only designed to generate a hypothesis that should then be tested by clinical research.  This is an important distinction, because many times the hypotheses don’t pan out.  We’ve seen this happen many times in nutritional epidemiology studies over the years.  Recall two of the big mishaps:

  • Eggs being demonized because of their cholesterol content. 
  • All fat was considered bad.  Fat-free was better. 

Nutrition epidemiology studies produced those conclusions but such studies simply cannot get granular enough to produce real insight. Clinical research proved them to be inaccurate. 

Clinical research has already shown that lean red meat can not only be healthful but useful.  The BOLD study (Beef in an Optimal Lean Diet) showed that lean beef – about 4 oz daily, you don’t need any more than that – found that LDL-cholesterol was lowered as much as by the DASH (Dietary Approaches to Stop Hypertension) diet that offered only an ounce of beef daily. 

A more recent study showed a greater reduction in LDL-cholesterol on a Med diet that contained MORE lean beef than the one with less lean beef. 

Proteins from plants AND animals have a lot of nutritional value. Regardless of the source, it’s best to keep ALL portions reasonable.  Three or 4 ounces of animal protein (or the plant-equivalent) per meal is all that’s needed. Then fill out with fruits, veggies, and whole grains on your plate.

Cut-to-the-Chase-Nutrition Take-Away

You’ll never stop seeing these population studies.  They’re easy to do, they generate huge databases and they give researchers the ability to publish papers for years.  Just see them with some healthy skepticism and know they aren’t capable of producing ANY cause-and-effect conclusions – no matter what the headline might imply.  Solid, clinical studies usually give a better picture that’s far more likely to be meaningful in the real world.  IMHO.

Depressed? Some Fruits and Veggies Might Help!

When I was a kid, and for basically my entire life, having a (huge) slice of watermelon – or two or three, made me happier than eating cake.  Yeah, watermelon made me happy.  But could eating more fruit – and veggies – make you less depressed?  Some new research says that’s not a far-fetched notion.

This review in the American Journal of Clinical Nutrition evaluated the body of studies that investigated the effects of eating fruits and vegetables on various measures of mental health.   The authors wanted to see if an actual causal relationship existed, so they looked at both experimental studies and observational studies.

This review included studies that reported fruits and vegetables together, as well as those that looked only at intakes of vegetables or fruits.  Being this specific really pared down the pool of eligible studies, but they did find ten that met the criteria, and these included over 33,000 people.

Watermelon may not cure depression, but I am ALWAYS happy when I’m eating it!

The authors concluded that increased fruit and vegetable consumption had a “positive effect on psychological well-being”, with vegetables having somewhat more impact than fruits, in studies that looked at the effects independently.  The effect on mental health however, was less clear. 

Basic Brain Chemistry

There may be some chemical reasons for the improved mental outlook from eating more produce.  Fruits and vegetables are loaded with micronutrients like vitamin C and B-complex vitamins, that influence the formation of neurotransmitters, such as serotonin, dopamine, and norepinephrine in the brain.

Neurotransmitters are known to influence our mood and impact mental health.  Indeed, many medications that treat depression are focused on modulating neurotransmitters like serotonin, to optimize their impact on mental health, depression, and psychological well-being.

Chicken vs. Egg

My first response was, “did the fruit and vegetable consumption improve their psychological well-being, or was their consumption of fruits and vegetables higher just because they had a better sense of well-being in the first place.  The latter would be called “reverse causality”. 

The amount of fruits and vegetables needed for “meaningful changes” varied among studies, ranging from 3.7 servings to 7-8 servings.  Counting a typical “serving” as about ½ cup, you’re looking at from 2-4 cups per day to have an effect.  This is well within recommended amounts by pretty much all global health authorities.

A simple “modified-Mediterranean diet”
seemed to modify depression as well

While this review didn’t include clinical research, a 2017 clinical study looked directly at the impact of increasing adherence to a “modified-Mediterranean” diet, which emphasizes fruit and vegetable consumption, as adjunctive treatment in persons diagnosed with moderate to severe depression.  Scores on the Montgomery–Åsberg Depression Rating Scale (MADRS) were used as a measure of the severity of depression.  This study checked some important boxes for quality of design:

  • Randomized controlled trial.
  • Parallel groups.
  • Some received regular nutrition counseling on a modified Mediterranean diet, others received social support on the same schedule.

Result: The dietary intervention group had significantly improved scores.  Even better, 32% of the dietary intervention group achieved remission of their depression, vs 8% in the social support group, and these results were statistically significant. 

The dietary group also at significantly more:

  • Fruits
  • Dairy foods
  • Fish
  • Pulses (beans, peas)
  • Nuts

They also ate fewer servings of less nutritious items, like sweets and, empty-calorie foods.

The study lasted only 12 weeks, so further research that addresses longer term results and with larger groups, is certainly warranted.  Still, given a relatively simple intervention that just encourages people to eat a diet that’s balanced and includes what they need anyway, it’s hard to dismiss the value of results. 

Cut-to the-Chase Take-Away

Aa clinician, I care mostly about people eating as many of each as possible and I’m less fussy about fruits vs. veggies.  None of them are nutritious unless you eat them and all of them are good for us.  Eat the ones you like and eat them daily.  You’ll certainly be happier with your choices!

When Did “Plant-based” Become “Plants ONLY”?

When the New York State Assembly said so.  They recently passed A04072,, requiring all hospitals to – upon request – offer  “a plant-based food option as an alternative to every meal or  snack  offered  in  food service  to  the patient.”  In addition, all the hospital’s written material describing food offerings must now include the availability of a plant-based food option.

They take it a step further by defining “plant-based” as plants-only:

  • “Plant-based food option” means a food or beverage that is free of animal products and that has nutritional value comparable to the non-plant-based food option that it replaces.
  • “Animal product” means meat, poultry, seafood, dairy, eggs, honey, and any derivative thereof.

“Basically they are saying “plant-based” equals vegan,” said Toby Amidor, a NY-based registered dietitian nutritionist and best-selling cookbook author. “Those are two separate entities. [The State Assembly] is defining it as they wish.” 

Historically, “plant-based diet” has always meant plant  dominant, whereas vegan diets are exclusively from plants.  By the NY Assembly’s definition, even honey is excluded (bees are tiny but they’re animals).   

“Comparable Nutritional Value”? No Such Animal

Add a sprinkle of grated parmesan?
Oops! Then won’t be “plant-based”!


As for the bill’s requirement that the “plant-based” meals and snacks have a “nutritional value comparable to the non-plant-based food option that it replaces”, this is a huge ask.  “It might sound good on paper but it’s not truly possible,” according to registered dietitian nutritionist and certified diabetes educator Melissa Joy Dobbins.  “Offering plant-based options is one thing, but requiring them to be nutritionally comparable is problematic.” 

Nature just doesn’t work like that – there just isn’t always an ideal plant-based counterpart for an animal food, nor vice-versa.  Milk and yogurt are perfect examples.  There are plant-based alternatives, but none is nutritionally equivalent.  This is the whole premise of eating a varied diet.  The more food groups you exclude, the more nutritional risks you take. 

Dobbins added, “Implying that it’s a simple swap is misguided at best, and has the potential to contribute to nutritional deficits in an already compromised patient population.”  Hospital patients often have poor appetites, yet their protein needs can be higher than normal, due to the stress of surgery and illness.  Elderly patients at bedrest for an extended period lose muscle mass faster than younger counterparts, and may benefit from a diet that contains extra protein of the highest quality, such as in meat, dairy foods and eggs, and in less volume than a vegan diet would need to provide the same protein.

A “Solution” In Search of a Problem

What did hospitalized vegans do BEFORE this legislation?  “Accommodating vegan patients is standard,” according to Jessie Pavlinac, a chief clinical dietitian at the Oregon Health and Science University hospital in Portland and past president of the Academy of Nutrition and Dietetics. 

Pavlinac noted that hospitals would be cited by accreditation bodies for not having options for vegetarians and vegans.  

Cut-To-The-Chase Nutrition Advice

Dairy foods — and meat — can be in
YOUR plant-based diet, and for good reasons!

As consumers muddle through this “plant-based/plants-only” forest, there are a few facts – not hype – to remember about these terms:

  • “Plant-based” and “vegan” are NOT health claims.
  • Neither term indicates dietary quality.
  • These terms are simply descriptive, nothing more.

Defining plant-based to mean “excludes all animal foods” is incorrect and confusing.  Does the delicious salad pictured being “plant-based” if you sprinkle some parmesan over it?  Of course not, and no law should say otherwise — IMHO.

My guess is that the “nutrition-naïve” legislators were strongly influenced by lobbyists with a vegan agenda.  The bill still has significant hurdles in the Senate and the governor’s office before it could become law, but a similar bill was signed into law by California’s Governor Jerry Brown.  

Featured image courtesy of www.inkmedia.eu

Got a Salty Tongue? New Study Says It’s Not So Bad!

Hypertension and “low-sodium diet” seem to go together like two peas in an unsalted pod.  Salt, has been one of the “eat less of” ingredients that dietary guidelines and health organizations have warned us about forever.  We’ve been told of the risks to our blood pressure and heart health in particular.

In the US, we get about 3,500-4000 mg of sodium daily, according to the Centers for Disease Control   (women tend to be on the lower end of this range).  You may exceed these levels if you eat out a lot, as restaurant chefs are known for their generosity with salt.  US Dietary Guidelines recommend a max of 2,300 milligrams, and if you’re at risk for cardiovascular disease, it’s only 1,500 mg.  Even at 2,300 mg, it means cutting out a third of the sodium we eat.

Kimchi: Yes, it’s salty, but it’s OK,
just don’t binge!

The problem?  People HATE low-salt diets and they love salty food!   Even excluding French fries, these foods also figure into our love of salty savories:

  • Grandma’s chicken soup (and most canned or homemade soups)
  • Cured meat, fish (smoked salmon!) and cold cuts
  • Most condiments, from Worcestershire sauce to anchovy paste
  • Most ethnic dishes and restaurant meals
  • Almost everything savory that‘s canned or jarred (pasta sauces, tomato sauce, baked beans, and on)

S.O.S.: Save Our Sodium?

This study looked at just how bad the present intake of sodium is for our health and it turns out sodium may be a minor player. 

The study estimated sodium intake by assessing sodium in the urine (where 90% of our sodium ends up) and divided the groups into low, medium, and high excretion groups and followed them for about 8 years, looking at risk for cardiovascular events and death.

Interestingly, the groups at the most risk had both the highest and the LOWEST intakes of sodium, but only when they also had a low intake of potassium. 

The group with the LOWEST risk for death and cardiovascular events?  They had a moderate sodium diet (3.000-5,000 mg/day) but diets that were highest in potassium. 

D.A.S.H.-ing Through the Clutter

A diet that’s moderate in sodium but high in potassium.  That’s pretty much the DASH diet: “Dietary Approaches to Stop Hypertension”.  It works and it’s simple.  Just eating more fruits, vegetables, and low-fat and fat-free dairy foods (milk is an astoundingly good source of potassium) does the trick, and it’s what most people’s diets need more of anyway.  Here’s why I like the DASH approach:

  • It’s not regimented or prescriptive. It’s an eating style that works with all cuisines.
  • Plenty of delicious foods are also loaded with potassium. Eat your favorites and eat them daily. 
  • Bonus: eating more fruits, veggies and low-fat dairy foods will probably push out some of the higher-salt foods people eat now, especially for snacks.

ALL fruits and vegetables are good sources of potassium, but here are some superstars:

  • All melons and berries
  • All citrus fruits and juices (100% juice, please)
  • All potatoes, squash, pumpkin
  • All leafy greens (lettuce, spinach, kale, the whole lot)
  • Beets (don’t laugh – beets are the new “in” veggie for 2019!)
  • MILK!  Whole, 2%, 1% and fat-free, also yogurt are the top non-plant sources of potassium – and calcium.

Reality: It Doesn’t Have to Bite

High-potassium foods are a “must-have.” More important than “low-sodium”!

People in the free-living world aren’t going to stop eating their favorite savory foods and they shouldn’t have to.  It’s time we accepted that and focused on encouraging everyone to eat more high-potassium foods. This latest study suggests it may be more effective anyway.

While the research continues, make sure your favorite savories keep better company:

  • Ham sandwich?  Instead of the chips and soda, try an apple or banana and some iced tea.
  • Going out to dinner?  Start with a salad – dressing on the side so you stay in charge.  Have a nice baked potato – sour cream has no sodium! 
  • Soup’s on?  Add some beans and greens for good measure.
  • Bacon and eggs?  Lox and bagels?  Have a fruit and yogurt parfait along with it.  Or at least a glass of OJ or a banana.
  • Get the herbs and spices into everything: soups, salads, meat, fish, even yogurt!  Dried or fresh, herbs and spices are loaded with antioxidants and replace the need for some of the salt.

There’s no requirement for a specific fruit or veggie to be healthy.  Just eating more fruits, veggies and dairy foods is a start and a good one.  It’s a super-tasty way to get healthier all-around – and just by eating, because these foods also fill nutrient gaps.  The benefits go way past getting more potassium. 

Did Your Child Eat 90 Cups of Strawberries This Morning?

If that happened, then be concerned with pesticide residues.  Everyone else can forget about the Environmental Working Group’s annual “Dirty Dozen” list.  

I can always tell it’s spring — that’s when the EWG issues it’s list of fruits and veggies with pesticide residues, just when people are looking forward to spring and produce.  The EWG’s message is always the same:  Avoid the Dirty Dozen.  And the failures of their message are also the same:


AGAIN, the EWG fails to put pesticide use into context and AGAIN, that’s irresponsible. (Example: even a child would have to eat 181 servings (about 90 cups) of strawberries, the #1 food on Dirty Dozen list, to exceed safe levels. An adult male would need to eat 635 servings (about 317 cups) of strawberries. 

AGAIN, the EWG doesn’t mention the pesticides used in organic agriculture.  There are hundreds of them, and even a few dozen synthetic ones that are allowed under certain circumstances – while still allowing the food to carry an “organic” label.

AGAIN, consumers should be reminded that the feds have been looking at this for decades, through its Pesticide Data Program.

The “Villains”

Kale: The new addition to the “Dirty Dozen”
  1. Strawberries
  2. Spinach
  3. Kale
  4. Nectarines
  5. Apples
  6. Grapes
  7. Peaches
  8. Cherries
  9. Pears
  10. Tomatoes
  11. Celery
  12. Potatoes

It Really Is ALL Good

You’ve heard that “the dose makes the poison.”  It’s true, but the dose also brings the benefit.  Let’s remember: ALL the research proving the healthfulness of eating plenty of fruits and vegetables – fresh, canned, frozen, dried – throughout our lives, was done using CONVENTIONALLY grown produce, not organic. 

Organic is just another choice.  If buying organic gets you eating more fruits and vegetables, then terrific!  But if you can’t find them, can’t afford them, or simply want to eat healthful food that’s also more economical, then the conventionally-grown option is fine.  I eat organic produce sometimes, when it’s convenient and reasonably priced.  I also eat ALL the conventionally-grown produce on the “dirty” list. 

No, I Won’t Peel My Apples

Eat the peels! There’s good stuff there!

That may remove pesticide residues but it’s probably healthier to eat the edible peels and skins on produce – they’re loaded with antioxidants and prebiotic fiber.  The research supporting eating fiber outweighs the near-non-existent negative research on pesticides on our food.  It’s also a huge waste to throw away these edible portions.


My EdibleRx about LAST YEAR’s Dirty Dozen holds as true today as it did then, except that kale made this year’s list, bumping off sweet bell peppers. Yawn.  If you hate kale, you’re thrilled.  But if you like it, then it won’t kale you to keep eating it without concern.  

Still Have Doubts?

Get the facts.  This cool tool calculates how many servings of one of the Dirty Dozen a man, woman or child would have to eat before pesticides could become a concern.  It’s from the Alliance for Food and Farming – a non-profit organization of BOTH organic and conventional growers of fruits and vegetables on all sizes of farms.